Chairman Benishek, Ranking Member Brownley and members of
the Subcommittee, on behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and our Auxiliaries, I want to thank you for
the opportunity to present the VFW’s stance on legislation pending before this
Subcommittee. Your hard work and dedication to improving the quality of
veterans’ health care positively impacts the lives of all those who have served
our nation’s military. The bills we are discussing today are aimed at
continuing that progress and we thank the Committee for bringing them forward.

H.R. 183, Veterans
Dog Training Therapy Act:

This legislation would require the Department of Veterans
Affairs (VA) to establish a pilot program at three to five facilities to assess
the effectiveness of treating veterans for post-traumatic stress disorder
(PTSD) by instructing them in the art of service dog training. The Palo Alto VA Medical Center (VAMC) has
been operating a similar program since 2008 in partnership with the Bergin
University of Canine Studies, known as Paws for Purple Hearts, which resulted
in positive feedback from veterans and staff.

The VFW recognizes the potential value of canine therapy and
would not be opposed to a limited pilot program for the purpose of collecting
data to determine its effectiveness in treating veterans for PTSD. We do, however, have suggestions that we
believe would strengthen H.R. 813, which we hope the subcommittee would
consider, should this bill be advanced to markup.

VA has been directed by Executive Order to establish
community mental health partnerships, and numerous organizations around the
country have expertise in the field of service dog training. We believe that the collaboration with the
Bergin University of Canine Studies has benefitted the Paws for Purple Hearts
program, and similar relationships should be encouraged going forward. For this reason, we suggest that the bill be
amended to allow VA to carry out the pilot program at the selected sites in
partnership with existing community resources.

We also believe that it may not always be appropriate to
kennel dogs on the grounds of VA medical facilities. The VFW is concerned that noise, sanitation,
and available space could present problems for VA facilities tasked with the
primary mission of delivering health care to veterans. We recommend the bill be
amended to allow VA the flexibility to house and train the dogs at off-site
locations when necessary. With the above changes, the VFW would fully support
this legislation.

H.R. 2527, to amend
title 38, United States Code, to provide veterans with counseling and treatment
for sexual trauma that occurred during inactive duty training:

The VFW supports this legislation which would authorize VA
to provide counseling and treatment to service members who experience military
sexual trauma (MST) during inactive duty training. VA policy states that veterans are entitled
to treatment for all physical and mental health conditions determined by a VA
provider to be related to MST, without the need for service connection or other
enrollment qualifications. Current law, however, narrowly defines MST as having
occurred while the service member was on active duty or active duty for
training status. This means that many
veterans who experienced MST on inactive duty, but while still in uniform,
cannot receive the care they need.

VA is aware of this loophole, and included proposals to
expand eligibility for MST treatment to those who experienced MST during
inactive duty in their FY 2014 and FY 2015 budget requests. The VFW agrees that members of the Reserve Component
who experience sexual trauma during weekend drills or other inactive duty
should be entitled to the same MST-related services as those who experience
sexual trauma while activated, and we encourage the subcommittee to move
quickly on this critical legislation.

H.R. 2661, Veterans
Access to Timely Medical Appointments Act:

This legislation would codify the 2012 VA goal of completing
all primary care appointments within seven days of the desired date and all
specialty care appointments within fourteen days of the desired date. Additionally, it would require VA to comply
with several recommendations of a March 2012 Government Accountability Office
(GAO) report including: eliminating scheduler error, providing reliable
appointment wait time data, standardizing the scheduling policy across all
Veterans Integrated Service Networks (VISNs) and VAMCs, restricting the
scheduling system to those who have been properly trained, improving veterans’
phone access, and routine assessments.
Although the VFW strongly supports the recommendations of GAO and the
intent of this legislation to reduce appointment wait times for veterans, we do
not support a statutory mandate of VA’s appointment wait time goals at this
time.

In the past, VA has tried to enforce scheduling policies and
wait time standards without proper training of staff and using flawed tracking
programs. GAO found that this often led
to data manipulation by staff in an effort to falsely create the appearance of
short wait times. We are concerned that
codifying the VA wait time goals would apply so much pressure that it would
encourage further data manipulation in order to comply with the law. Transparency and honest self-assessment will
be necessary to truly reduce the wait times experienced by veterans.

Complicating the well-known deficiencies in VA appointment
scheduling is the fact that VA is still in the process of establishing
productivity standards to determine appropriate physician staffing levels at
its facilities. Simply put, it is impossible
to achieve the greatest level of access if too few providers are available to
meet the demand for care. Accurate
appointment scheduling and proper physician staffing must both be achieved in
order to solve the problem of long appointment wait times.

The VFW is also concerned that this legislation would force
VA to over-utilize purchased care in order to meet its mandates. VA’s new purchased care model, Patient-Centered
Community Care (PC3), is still being implemented. Its effectiveness is still unknown, and it
may not be the best option for many veterans.
The VFW wants to see PC3 succeed, but as a secondary option to direct
care, as it was intended, not as VA’s only option to comply with the law. Suddenly sending large numbers of veterans
out of VA for care would not solve the appointment wait time problem at VA
facilities, only camouflaging it.

VA should be given the opportunity to implement its plans
for appointment scheduling, physician staffing, and purchased care before its
self-imposed wait time goals are written into law. Furthermore, VA should not be discouraged
from setting ambitious goals in the future out of fear that their announcement
will be quickly followed by statutory mandates.
In order to solve the problem of long appointment wait times, the VFW
urges continued congressional oversight to ensure that VA complies with GAO and
VA Office of the Inspector General (OIG) recommendations.

H.R. 2794, to amend title
38, United States Code, to provide for the eligibility for beneficiary travel
for veterans seeking treatment or care for military sexual trauma in
specialized outpatient or residential programs at facilities of the Department
of Veterans Affairs, and for other purposes:

The VFW supports this legislation which would extend beneficiary
travel benefits to veterans seeking care at VA facilities for conditions
associated with MST. VA currently
provides care for all physical and mental health conditions determined by a VA
provider to be related to MST, without the need for service connection. This care is provided with no copay charges and
without any income eligibility requirements.
Qualifying veterans are eligible for residential rehabilitation
treatment programs, and facilities that do not have those programs have been
directed to refer veterans to those that do in order to guarantee access. This means that some veterans have to travel
significant distances to receive MST care.

VA travel benefits are currently available to veterans who have a
service-connected (SC) rating of 30 percent or more, are traveling for
treatment of a SC condition, are eligible for pension, or are traveling for a
scheduled compensation and pension examination.
Not all veterans eligible for MST care are included in one of those
categories. As a result, many MST victims may have to forgo the care they need
and deserve, simply because they cannot afford the costs of traveling to
facilities that are able to provide that care.

OIG identified this as a problem in a December 2012 report, stating
that VHA beneficiary travel policies are not properly aligned with MST
policy. They recommended that the travel
policy be reviewed. As of now the travel
policy has not changed. This legislation
would fix the problem by adding veterans who are receiving MST treatment to the
list of eligible travel beneficiaries.

H.R. 3508, to amend title
38, United States Code, to clarify the qualifications of hearing aid
specialists of the Veterans Health Administration of the Department of Veterans
Affairs, and for other purposes:

This legislation would authorize VA to hire hearing aid
specialists as full time employees at department facilities to provide hearing
health services alongside audiologists and hearing health technicians. Hearing aid specialists would assume the
responsibilities of performing in-house repairs, currently performed by
technicians, and fitting and dispensing hearing aids, currently performed by
audiologists. Although we appreciate
this bill’s intent to increase hearing health access and reduce wait times for
hearing aids and repairs, the VFW believes that VA has the ability to address
these issues under its current hiring authority.

The VFW strongly believes that VA must improve timeliness in
issuing and repairing hearing aids. A
February 20, 2014 OIG report revealed that 30 percent of veterans are waiting
longer than 30 days to receive new hearing aids, and repairs take an average of
17 to 24 days to complete, far exceeding the VA 5-day timeliness goal for those
services. According to the report, the
long wait times can be attributed to a steadily increasing work load, which
will likely continue to increase as the veteran population grows older. This problem is compounded by the fact that
many audiology clinics are not fully staffed.
Additionally, OIG found that the Denver Acquisition and Logistics Center
(DALC), which performs major hearing aid repairs for VAMCs nationwide, lacks an
adequate tracking system for the devices it receives.

To address these problems, OIG recommended that VA develop
and implement productivity standards to determine proper staffing levels in
audiology clinics, and establish tracking controls for the hearing aids
received by the DALC. VA concurred with
these recommendations and will include audiology in its implementation plan for
productivity standards. In our opinion,
this is the correct course of action.
The VFW believes that adding a new class of provider whose scope of
practice overlaps that of existing employees does not get to the root of the
problem. To fully address the issue, VA
must determine the proper staffing levels of audiologists and hearing health
technicians necessary to meet timeliness standards and increase the numbers of
those employees accordingly.

H.R. 3180, to amend title
38, United States Code, to include contracts and grants for residential care
for veterans in the exception to the requirement that the Federal Government
recover a portion of the value of certain projects:

The VFW supports this legislation which would allow state veterans
homes that receive residential care contracts or grants from VA to also
contract with VA under the Health Care for Homeless Veterans (HCHV) supported
housing program. Since state veterans
homes receive VA funding for other programs, the recapture clause of section
8136 of title 38 prohibits them from receiving HCHV funds. Only those state
veterans homes that also run outpatient VA clinics are currently exempted from
the recapture clause. This means that
many state veterans homes with empty beds are unable to offer them to homeless
veterans in their communities. Similarly
exempting them from the recapture clause would solve this problem.

The Secretary’s ambitious five year plan to end homelessness among
veterans includes six strategic pillars. The sixth pillar is community
partnerships, which certainly must include state veterans homes. The VFW strongly supports the Secretary’s
five year plan and believes that state veterans homes should be utilized to the
fullest extent possible to ensure its success.
As long as there are homeless veterans who need them, beds in state
veterans homes should not remain empty simply due to the unintended
consequences of a federal regulation.

H.R. 3387, Classified
Veterans Access to Care Act:

The VFW supports this legislation which would require VA to develop
standards and disseminate guidance to ensure that veterans who participated in
sensitive missions or were assigned to sensitive units are able to access
mental health services in a way that does not require them to improperly
disclose classified information.

We are aware that this legislation was inspired by the case of Daniel
Somers, a veteran of sensitive missions in Iraq, who felt that he was unable to
participate in the group therapy sessions offered to him at the Phoenix VAMC,
believing that he would be required to share classified information with other
group members. Tragically, Daniel Somers
took his own life last year. The VFW has
been in contact with his parents, who strongly believe that had their son been
offered individual therapy from the beginning due to the nature of his service,
his suicide may have been prevented. The
VFW believes that requiring VA to develop standards for those who served on
sensitive missions is reasonable, and would ensure that veterans feel that they
can access the services they need without violating any nondisclosure
responsibilities they may have.

H.R. 3831, Veterans
Dialysis Pilot Program Review Act of 2014:

The VFW supports this legislation which would prohibit VA
from expanding the dialysis pilot program until the program has operated at
each initial facility for at least two years, an independent analysis has been
conducted at each facility, and a report is submitted to Congress.

A May 2012 GAO report found that VA was planning to expand
the pilot, despite not having developed adequate performance measures to
evaluate the existing locations. While
the GAO report focused primarily on cost, the VFW is pleased that the report
required by this legislation would also examine non-cost factors such as
access, quality of care, and veteran satisfaction.

The purpose of any pilot program should be to assess its
strengths and weaknesses on a small scale in order to decide whether or not it
should be expanded. If and when it is instituted
on a large scale, it should be done based on a detailed analysis and lessons
learned from the pilot. Therefore, we
believe it is both reasonable and prudent to require VA to submit a detailed
report on the dialysis pilot program before it is allowed to expand.

H.R. 4198,
Appropriate Care for Disabled Veterans Act:

The VFW supports this legislation which would reinstate the
requirement for VA to submit an annual report to Congress on its capacity to
provide for the specialized treatment and rehabilitative needs of disabled
veterans. This requirement expired in
2008 and since that time, it has become apparent that the capacity of VA
specialty care has been inadequate to meet veteran demand. The VFW believes that current accurate data
on VA capacity will greatly assist Congress in conducting oversight on
veterans’ access to care.

Since the report was first mandated in 1996, many changes
have been made in the way VA provides specialty care. We look forward to working with the
subcommittee and our Independent Budget
Veterans Service Organization (IBVSO) partners to identify any necessary
updates to the original reporting requirements to ensure future reports are
relevant and actionable.

Draft Bill, to
authorize major medical facility projects for the Department of Veterans
Affairs for fiscal year 2014:

This legislation provides VA the authority to enter into 27
major facility leases, allows VA to construct or lease joint VA/Federal use
medical facilities, expands VA’s Enhanced-Use Lease (EUL) authority, and
modifies the authority to build a major medical facility project in Tampa,
Florida.

Sections 1, 2 and 3 provide authorization for VA major
facility leases. It is critical that VA is provided the authority to enter into
the 27 major medical leases. Many of these leases have been awaiting
authorization for nearly two years. Most of these facilities are
Community-Based Outpatient Clinics (CBOC) that have provided direct medical
care in the communities where veterans live. However, since the current leases
have expired and there is a need to expand capacity or change the physical
location of the CBOCs to better serve the needs of veterans, VA must enter into
new leases.

Congress had failed to authorize these leases because of the
Congressional Budget Office’s revised scoring model, which now requires VA to
account for the full lease amount in the first year of the lease. Congress must
find a workable solution to allow VA to continue its major capital leasing
projects. Failing to pass this authorization into law will create greater
access and timeliness issues for veterans, and in the end cost VA more as they
begin reimbursing veterans for travel to distant medical centers or pay for
fee-based care in the community. The VFW fully supports these provisions and
their quick passage.

Section 4 amends VA’s current medical facility construction
and leasing authority to allow VA to enter into joint acquisitions and leases
with other Federal agencies. Currently, when VA sees the value in co-locating a
medical or research facility with another agency, either VA or the other agency
must already own the property and grant the other agency a portion of the
property through an acquisition by exchange. By amending the current authority,
VA will be able to reduce construction and/or lease costs by acquiring,
planning and building facilities jointly. The VFW sees the value in this
authority and we fully support this provision.

Section 5 amends VA’s authority to enter into EULs. In 2012,
VA was forced to modify its EUL authority, greatly reducing its ability to
lease out its unused or underutilized properties. This authority will greatly
widen VA’s lease options, thereby producing revenue and reducing the number of
unused or underutilized properties in VA’s inventory. The VFW understands that
when VA property is unused or underutilized, VA still incurs significant costs
to maintain it, ultimately squandering resources that could be better used
serving veterans. This is why the VFW supports the idea of expanding VA’s
leasing authority, but we must also point out that VA must make every effort to
lease these unused or underutilized properties for projects that directly
support veterans and their families before considering other leasing projects.

Sections 6 and 7 authorize modification and the
appropriations for the major medical project in Tampa Florida. VA has requested
that a previously authorized upgrade to the medical facility bed tower be
reauthorized as a new bed tower at the Tampa, Florida medical center. The VFW
supports this modification.

Mr. Chairman, this concludes my testimony and I look forward
to any questions you and the members of this subcommittee may have.

Information Required by Rule XI2(g)(4)
of the House of Representatives

Pursuant to Rule XI2(g)(4) of
the House of Representatives, VFW has not received any federal grants in Fiscal
Year 2013, nor has it received any federal grants in the two previous Fiscal
Years.